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중환자실에 입원한 급성 신부전 환자에서 지속적 신대체요법
황은아 ( Eun Ah Hwang ),윤정수 ( Jeong Soo Yoon ),장미현 ( Mi Hyun Jang ),김정은 ( Jung Eun Kim ),강성식 ( Seong Sik Kang ),최고 ( Go Choi ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6
Purpose: The mortality rate in critically ill patients with acute renal failure (ARF) remains unacceptably high, despite numerous advances in dialysis techniques and intensive care medicine. We evaluated clinical characteristics and prognostic factors in ICU patients with ARF requiring continuous renal replacement therapy (CRRT). Methods: We retrospectively reviewed the medical records of all ICU patients who received CRRT at the Keimyung University Dongsan Hospital from September 2002 to October 2007. Results: Total number of patients who required CRRT in ICU was 58. The mean age was 58.3±14.8 years. The treatment duration of CRRT was 63.5±40.7 hours. The mechanical ventilation rate was 82.8%, vasoactive drug 79.3%, sepsis 39.7%. APACHE II score was 25.2±7.9, SAPS II score 48.1±15.1, CCF score 9.3±3.6, the number of organ dysfunction 2.1±1.3. Overall mortality rate was 48%. When we compared sepsis group with non-sepsis group, the number of organ dysfunction and severity of illness were significantly higher in sepsis group than that of non-sepsis group. A mortality rate of sepsis group was significantly higher than non-sepsis group (82.6% vs 31.3%, p<0.001). In univariate analysis, significant risk factors for mortality were the number of organ dysfunction, severity of illness, MAP, platelet count, serum albumin level, and a type of hemofilter. Significances of all these factors were lost in multiple linear regression analysis. Conclusion: A large scaled, prospective randomized multi-center trials are needed to confirm the beneficial effect of CRRT in patient with ARF in ICU.
무선망에서 데이터 전송 향상을 위한 SCTP SNOOP 적용 연구
황은아(Hwang Eun-Ah),송복섭(Seong Bok-Sob),김정호(Kim Jeong-Ho) 한국콘텐츠학회 2007 한국콘텐츠학회 종합학술대회 논문집 Vol.5 No.2_1
최근 유무선 혼합망의 사용이 증가됨에 따라 무선망의 핸드오프, 경로 손실, 페이딩, 등과 같은 전송 오류의 원인을 개선하기 위한 연구가 전개되고 있다. 유선의 신뢰성을 보장하는 표준 TCP, SCTP를 무선망에 적용하는 것은 혼잡제어, 흐름제어의 메커니즘을 적용함으로써 데이터 전송의 효율을 저하시킨다. 본 연구는 무선망에서 SCTP를 적용하기 위해서 SCTP와 SNOOP을 혼합하는 것으로, 무선망에서 전송오류가 발생했을 때 BS의 동작과정을 개선한 것이다. BS (Basic Station : 기지국)는 전송오류 시 ZWP(Zero Window Probe)를 MN(Mobile N여:e이동노드)에게 보내어 경로와 상태를 확인하고 RWND를 갱신하여 에러상태를 확인한다. 그리고 새로운 경로를 선택하고, FH(Fixed Host : 고정호스트)에게는 ZWA(Zero Window Advertisement)를 보내어 혼잡제어나, 흐름제어 메커니즘을 호출하는 것을 방지하고 대기상태로 기다리게 한다. 무선망의 연결이 안정된 후에 데이터 전송을 함으로써 데이터의 전송 효율을 약 10% 향상한다. Recently the use of wireless network increases according to it solves the hand-off and with path loss, pading, noise etc of wireless network the research for transmission error improvement is developed. TCP and SCTP of standard where it guarantees the reliability of wire network apply in wireless network the congestion control, flow control mechanism used it decreases the efficiency of data transfer throughputs. In this paper, It mixes SCTP and SNOOP for SCTP apply on wireless network, to improve BS(Basic Station) operation processes when the transmission error occurs in wireless network. BS send ZWP(Zero Window Probe) to MN(Mobile Node) when the transmission error occurs so, check path and status and update RWND and error status checked. It selects the new path, send ZWA(Zero Window Advertisement) to FH(Fixed Host) and the prevents call to congestion control or flow control and it does to make wait status standing. Continuously of data transfer after the connection of wireless network is stabilized, it make increase about 10% the transmission throughput of data.
황은아(Eun Ah Hwang),성정훈(Jung Hoon Sung),한승엽(Seung Yeup Han),박성배(Sung Bae Park),김현철(Hyun Chul Kim),김형태(Hyung Tae Kim),조원현(Won Hyun Cho) 대한내과학회 2002 대한내과학회지 Vol.63 No.3
목적 : 복막투석 환자에서 복막염은 복막투석의 실패와 사망에 가장 중요한 합병증의 하나이다. 저자들은 계명대학교 동산의료원에서 복막투석을 시행한 환자들을 대상으로 하여 복막염의 발생 및 역학에 대해 조사하였다. 방법 : 1996년 1월에서 2000년 12월 사이에 계명대학교 동산의료원에서 복막투석을 시행받은 환자들 중 추적기간이 2개월 이상인 238명을 대상으로 하여 후향적으로 조사하였다. 결과 : 5년간의 복막염의 발생율은 평균 0.94회/환자-년(12.8개월당 1회)이었고, 복막염 원인균의 빈도는 그람 양성균이 41.7%, 그람 음성균이 14.1%, 진균이 1% 순이었으며 배양 음성인 경우가 42.7%였다. 그람 양성균 중에는 Staphylococcus aureus가 47.5%로 가장 많았고, 그람 음성균에서는 Acinetobacter가 29.6%를 차지하였다. 균배양 양성율은 Bactec 혈액 배양 방식의 도입 이전 52.5%, 도입 후 72.2%로 균배양 양성율이 유의하게 향상되었다. 복막염은 항생제의 사용으로 치료된 예는 85.6%였고, 11.8%에서는 도관이 제거가 필요하였다. 도관을 제거하였던 경우 출구 감염이 도관을 제거하지 않 았던 군보다 유의하게 많았다(17.4% vs 4.7%). 전체 109명의 환자 중 60예에서 복막투석을 중단하였고, 그 중 28예가 혈액투석으로 전환하였으며 그 원인으로는 복막염이 82.1%로 가장 많았다. 도관 생존율은 복막염을 경험한 환자군에서는 1년, 3년, 5년 도관 생존율이 각각 87.0%, 35.1%, 11.9%였으며 복막염을 경험한 환자군에서는 1년, 3년, 5년 도관 생존율이 각각 81.7%, 58.1%, 54.0%였다. 관찰 기간 동안 6예가 사망하였으며 그 중 절반이 복막염에 의한 패혈증으로 사망하였다. 결론 : 앞으로 복막염의 발생을 감소시키기 위해서는 투석액 교환시 감염 및 도관 주위감염에 대한 적극적인 치료와 주기적인 환자 교육이 필요할 것으로 생각된다. Background : Peritonitis is one of the major complication leading to mortality and technique failure in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We have examined the incidence and etiology of CAPD peritonitis at Keimyung University Dongsan medical center. Methods : Between January 1996 and December 2000, 238 new patients received peritoneal dialysis and were reviewed retrospectively. Results : In 238 patients, 109(45.8%) patients experienced peritonitis and a total of 192 episodes of peritonitis has occurred during study period. The overall incidence of peritonitis during CAPD averaged 0.94/patient-year and there was no essential change during the last five years. The most common causative organism was Gram positive organism (41.7%), followed by Gram negative organism (14.1%), and fungus (2%). In Gram positive organism, Staphylococcus aureus (47.5%) was the most common microorganism, followed by coagulase negative Staphylococcus (23.5%), Streptococci (7.5%), and Enterococci (5.5%). Gram negative organism were Acinetobactor (29.6%), Escherichia coli (18.5%), Klebsiella (18.5%) and Pseudomonas (7.4%) in decreasing order of frequency. With the use Bactec blood culture system for peritoneal fluid culture since April 2000, the culture yield has been improved significantly than before (52.5% vs 72.2%, p<0.05). Peritonitis was cured in 164 cases (85.6%) with the administration of antibiotics. However catheters had to be removed in 23 cases (11.8%). Exit-site infection was more frequent in catheter removal group than in catheter retaining group (17.4% vs 4.7%, p<0.05). The CAPD failure occured in 28 patients during study period, and peritonitis was the major reason for technique failure (82.1%). The catheter removal rate was significantly higher in the patients with peritonitis than those without peritonitis (55.0% vs 30.2%, p<0.05). There were six deaths during study period. Septicemia associated with peritonitis accounted for the half of the mortality. Conclusion : Better exit-site care and continuing patient education is needed the incidence of peritonitis and peritonitis related mortality in CAPD patient.(Korean J Med 63:314-321, 2002)
김정은 ( Jung Eun Kim ),황은아 ( Eun Ah Hwang ),곽진호 ( Jin Ho Kwak ),진규복 ( Kyu Bok Jin ),윤정수 ( Jeong Soo Yoon ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5
Purpose: The aims of this retrospective study were to evaluate the sequential changes of parathyroid hormone (iPTH) and calcium metabolism after renal transplantation (RTP) and to identify risk factors for hypertension (HPT). Methods : Biochemical bone parameters were reviewed in 264 patients at pre-transplant, 6, 12, 36 and 60 months after RTP. Results : iPTH levels fell significantly during the first six months after RTP and remained substantially stable thereafter. The mean total serum calcium level showed significant increase during the first six months and progressive and significant decline after the first year. The mean serum phosphorus level returned to the normal range during the first six months and remained normal thereafter. The serum alkaline phosphatase (ALP) level increased during the first year and gradually decreased after then. The prevalence of persistent HPT was 17.8%. Patients with persistent HPT had significantly elevated serum levels of iPTH at the time of RTP and had spent a longer time on dialysis. Significant positive correlations were observed between the serum iPTH levels on the one hand and the pre-transplant iPTH, serum ALP, and creatinine levels on the other hand. Conclusion: The prevalence of persistent HPT after RTP is not uncommon. The patients with long duration of dialysis showing high serum level of iPTH at the time of transplantation are at risk for persistent HPT.